Mid Illini Surgical Associates SC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

MID ILLINI SURGICAL ASSOCIATES SC

Practice address

900 Main St
Suite 530
Peoria, IL 61602-1074

Phone

(309) 672-5975

Fax

(309) 655-1678

NPI assigned

Feb 6, 2007

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Greg Totten

Title

Office Manager

Phone

(309) 672-5975

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer Lynn Edwards, CFA

  • Surgical Assistant
  • Peoria, IL
  • NPI 1215116124
  NPD (past)
• Joan K Selburg, CST

  • Surgical Technologist
  • Peoria, IL
  • NPI 1063538940
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1093854002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 MAIN STREET",
            "address_2": "SUITE 530",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021074",
            "telephone_number": "309-672-5975",
            "fax_number": "309-655-1678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 MAIN ST",
            "address_2": "SUITE 530",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021074",
            "telephone_number": "309-672-5975",
            "fax_number": "309-655-1678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID ILLINI SURGICAL ASSOCIATES SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "TOTTEN",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "309-672-5975"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jon Christopher Michel, MD
• Heather Michelini
• Paulo Roberto Kossatz Michelini
• Michelle Matzke Therapy, PLLC (Healing Blooms Therapy)
• Matthew Robert Michels
• Kristen Middendorf, OTR/L
• Midwest Business Partners LLC (Hear Always)
• Midwest Ear Nose & Throat Associates S.C.
• Midwest Eye Care PC
• Midwest Family Medical PC (Dr. Tim LaHood)

• Surgery Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.